CMS Formulary

Displaying 139661-139670 of 1611142 results.
ID: 139661
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 905158
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139662
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199376
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139663
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199381
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139664
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 898490
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139665
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 686429
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 139666
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 314142
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 139667
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311919
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 139668
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1988308
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139669
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1988311
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139670
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1988316
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0